Interview with Dr B Sadock

Dr Sadock speaks with LWW's Jenna Williams about developments in the field of mental health and the new edition of CTP

1. This is the ninth edition of Kaplan and Sadock's Comprehensive Textbook of Psychiatry to be published; what are some of the additions or updates we can expect to see in this edition?
This edition has over 50 new sections that have never appeared before that cover new topics and new advances in psychiatry.  Many previous contributors have been replaced by new contributors to keep the book current and vital.  The book has increased in size compared to the last edition with over 4000 pages of text.

2. You must have seen some great changes in the field of psychiatry since the Textbook was first published in 1967. Can you tell us something about these changes, and comment on how the Textbook has developed over its nine editions?
Since the first edition of CTP was published in 1967 there has been an explosion of knowledge in the neural sciences and psychopharmacology. For example, the first edition had only 35 pages covering the use of drugs in psychiatry; this edition has over 400.  In the area of neural sciences, the number of pages has increased more than 100 percent over that contained in the first edition.

3. One of the highlights of the book is the updated sections on Neural Sciences and Neuropsychiatry. What new developments have there been in these fields recently and why are they so important? 
Neural science covers a wide range of topics that range from functional neuroanatomy to the genetics of psychiatric disorders.  Advances in neurochemistry and neurophysiology have been enormous.  Neuroimaging has been particularly important in allowing behavioral scientists to see how the brain and mind function in both health and disease.

The neural sciences represent one of the fastest growing fields in psychiatry and every section has been updated and revised.  There are four new sections in this area.  They include Novel Neurotransmitters which describe the chemical messengers that influence behavior in health and disease and which are the cutting edge of the field. The Neural Science of Pain Systems is a new section that has direct application to diseases associated with severe pain and covers how doctors can use the latest knowledge to treat pain most effectively.  The Neural Science of Social Interaction explains how the brain functions in interpersonal relationships and a new section, the Basic Science of Self explains consciousness from a neuropsychological point of view.

4. Recently there has been a substantial amount of attention focussed on developing awareness of and treating mental disorders in low- and middle-income countries, where resources allocated to mental health awareness are limited. Do you have any thoughts on this?
Psychiatry has become global in scope enabling a greater awareness of the number of mentally ill around the world.  Organizations like the World Psychiatric Association and the World Health Organization would benefit from increased funding to attend to these needs.

5. What are some of the new directions regarding research on schizophrenia?
Understanding the cause of schizophrenia and developing effective treatment methods   for the disorder represents as much of a challenge as it did 50 years ago.  Great advances have been made in mapping the abnormal neural pathways and the disordered neurochemical factors that account for the signs and symptoms of schizophrenia; but there is still no cure.

There are now three sections instead of one [in the book] that cover the rapidly growing field of neuroimaging in schizophrenia:  Structural Brain Imaging, Functional Brain Imaging and Molecular Brain Imaging.  A new section, Post-partum Tissue Findings in Schizophrenia describes, for the first time in a major textbook, the actual brain changes that can be seen under the microscope in the brains of schizophrenic patients.  Three new sections, Phenotypes of Schizophrenia, Phenomenology of Schizophrenia and Psychosis as a Defining Dimension describe this disorder in a new and exciting way.  Other new sections include Medical Health in Schizophrenia and The Concept of Recovery in Schizophrenia.  Together, this section is the most comprehensive of any textbook published.

6. To return to the Textbook: Pedro Ruiz has been brought onboard as a co-author for the ninth addition for the first time. What prompted this addition, and what do you feel that Prof Ruiz has contributed to this edition?
Dr. Ruiz contributed immensely to the development of this new edition.  He is an expert in Transcultural Psychiatry about which he wrote a chapter in the book.  He was also instrumental in identifying experts in their respective fields and inviting them to participate.  He is President of the World Psychiatric Association and organized a section in the book on World Aspects of Psychiatry, which is unique. 

7. On a personal note, what has it been like to work on the Textbook with your wife, co-author Virginia Sadock, who is also a highly respected expert in the field?
When Dr. Harold  Kaplan, the founding editor of the textbook died in 1998, my wife stepped into the breach.  She had been active in all aspects of the textbook for many editions and had been thanked as the "unsung heroine" of the book by Dr Kaplan and me in the Preface of each edition.  She has sound judgment, excellent writing and editorial skills, and a personality that allows her to  interact   smoothly  with over 500 contributors.  It's a pleasure working with her.

 8. Anything else you would like to add?
Sir William Osler wrote a textbook of medicine that went into 16 editions.  When asked what it was like to be involved in publishing so many books he said:  "The birth of a successful textbook is like having a child. It keeps its author in unexpected bondage.  I have a plaque above my desk with that quote.